-- The right to control one's own body, define one's sexuality, choose one's partner and receive confidential, respectful and high-quality services are essential part of the new agenda.
Countries around the world must embrace a broader definition of sexual and reproductive health and rights that moves beyond disease prevention and contraception, and encompasses sexuality education, fertility services and counselling for gender-based violence as part of an essential package of health interventions, according to a new Lancet Commission on Sexual and Reproductive Health and Rights.
The Commission brings together the best available evidence and calls on governments around the world to tackle barriers embedded in laws, policies, the economy, and in social norms and values that perpetuate gender inequality and prevent people from achieving sexual and reproductive health and fulfilling their related rights.
The Guttmacher-Lancet Commission was led by the Guttmacher Institute (New York, US) and is the result of two years of work from 16 leading experts in the field. It will be launched today (9th May) in Johannesburg, South Africa [1].
To date, health and development initiatives have typically focused on contraception, maternal and newborn health, and HIV/AIDS. Many countries have made remarkable progress in these areas, but gains have been inequitable and services have often fallen short in coverage and quality.
Each year in developing regions, more than 200 million women want to avoid pregnancy but are not using modern contraception, more than 45 million women receive inadequate antenatal care, or none at all, and more than 30 million women deliver their babies outside of a health facility.
Worldwide, each year, 25 million unsafe abortions take place; between 49 and 180 million couples are affected by infertility, for which services are mainly available only to the wealthy; nearly two million people become infected with HIV; and approximately 266,000 women die from cervical cancer. About one in three women worldwide will experience gender-based violence at some point in their lives, most often from an intimate partner.
"For too long the world has accepted these stark realities as inevitable. Our report shows how they can be overcome, laying out a roadmap that countries can use to put essential services and interventions in place," says Ann M. Starrs, Commission Co-Chair and President and CEO of the Guttmacher Institute. "We have the means and the knowledge to achieve universal sexual and reproductive health and rights. Meaningful progress is possible, it is affordable and it is vital." [2]
The Commission proposes a new essential package of interventions that goes beyond the standard aspects of care such as contraceptive services, maternal and newborn care, and prevention and treatment of HIV/AIDS, to address neglected areas that include infertility services, prevention, detection, and counselling for gender-based violence, treatment and prevention of cervical cancer, safe abortion care, treatment and prevention of sexually transmitted infections other than HIV, and comprehensive sexuality education.
Almost 4.3 billion people of reproductive age have inadequate sexual and reproductive health services over the course of their lives. New analysis done by the Commission shows that meeting all needs for contraceptive, abortion, maternal, and newborn health services, including information, education, and counselling in in low-income and middle-income countries would require a minimum global investment of US$54 billion, equivalent to only $9 per capita annually. Evidence shows that access to sexual and reproductive health services saves lives, improves health and wellbeing, promotes gender equality, increases productivity and household income, and has multigenerational benefits by improving children's health and wellbeing. These benefits pay dividends over many years and make it easier to achieve other development goals, suggesting that investments in sexual and reproductive health services represent good value for money.
Alongside improvements in health care, the Commission calls on countries to tackle restrictive social norms, laws and policies, including the liberalisation of abortion laws where necessary, providing sexuality information and education, ensuring adolescents have access to sexual and reproductive health services and information without discrimination, and addressing entrenched gender norms of masculinity and femininity that promote or support gender inequality and unequal power in relationships.
"A starting point for improving sexual and reproductive health and fulfilling related rights is speaking frankly and accurately about sexuality and reproduction. For too long, issues related to human sexuality have been omitted from public policy, left out of the school curricula, and avoided in public discourse. Sexual and reproductive health and rights encompasses more than merely disease prevention; it includes the right to make decisions governing one's own body and to pursue a satisfying, safe and pleasurable sexual life," write the Commission authors.
The Commission also underscores the importance of gathering more evidence on the sexual and reproductive health needs of distinct populations that are often marginalized and vulnerable, including adolescents, people with diverse sexual orientations and gender identities, displaced people and refugees, and people living with disabilities.
"Gaps in sexual and reproductive health and rights worldwide take an enormous toll on individuals, communities and economies. We must not continue to tolerate this problem," says Dr Alex Ezeh, Commission Co-Chair and former Executive Director of the African Population and Health Research Center. "It's time to eliminate these inequities with a comprehensive approach that doesn't overlook critical components like access to safe and legal abortion, prevention of reproductive cancers, or treatment for infertility." [2]
The report is accompanied by three linked Comments from Dr Tedros Adhanom Ghebreyesus, Director General of WHO and Dr Natalia Kanem, Executive Director of the United Nations Population Fund; by Isaac Adewole, Minister of Health, Nigeria and Alejandro Gavira, Minister of Health and Social Protection Colombia; and by the editors of The Lancet.
In the Comment, Dr Richard Horton, Editor-in-chief of The Lancet and Dr Elizabeth Zuccala, Senior Editor, highlight examples from the USA, Latin America, and Eastern Europe where efforts to prevent access to sexual and reproductive health care have ramped up. They write: "Around the world, sexual and reproductive health and rights are under attack. Progress is not inevitable and the gains made to date cannot be taken for granted. If anything, more than two decades after International Conference on Population and Development, there has been one constant: women's bodies continue to be the battlegrounds on which ideological battles are fought, with devastating results... The Commission proposes the adoption of a new, expanded, and comprehensive definition of sexual and reproductive health and rights with an associated essential package of health services. Given the global context, this recommendation is not just bold, it is necessary."
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NOTES TO EDITORS
About the Commission: The Guttmacher-Lancet Commission consists of 16 commissioners from Africa, Asia, Europe, the Middle East, North America and Latin America, with multidisciplinary expertise and experience in a broad range of sexual and reproductive health and rights issues. From 2016 to 2018, the Commission held numerous consultations and synthesized available evidence with the support of researchers at the Guttmacher Institute, the African Population and Health Research Center and other organizations affiliated with several of the commissioners. The Advisory Group for the Commission consists of 23 representatives from sexual and reproductive health and rights, global health, and funding organizations who provided valuable feedback on the report and its recommendations.
Funding: The work for the Commission was supported by the Dutch Ministry of Foreign Affairs (The Hague, Netherlands), UK Aid from the UK Government (London, UK), the Norwegian Agency for Development Cooperation (Oslo, Norway), The William and Flora Hewlett Foundation (Menlo Park, CA, USA), the Swedish International Development Cooperation Agency (Stockholm, Sweden), the German Federal Ministry for Economic Cooperation and Development (Bonn, Germany), and The David and Lucile Packard Foundation (Los Altos, CA, USA).
[1] The launch event will feature Justice Edwin Cameron, Constitutional Court of South Africa; Richard Horton, Editor-in-Chief of The Lancet; and Julitta Onabanjo, Director for East and Southern Africa of the ?United Nations Population Fund.
[2] Quotes direct from authors and cannot be found in the text of the Commission.
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